Over the past decade there has been a growing realization that the fibromyalgia syndrome represents a very common cause of widespread musculoskeletal pain and fatiguability (A-C). According to a recent position paper by the American College of Rheumatology, fibromyalgia is now the second most common cause for rheumatology referrals after rheumatoid arthritis (D).
The pain experienced by fibromyalgia patients arises from their muscles and is activated by even minimal exertion. It has been hypothesized that the muscle pain in fibromyalgia patients is akin to the universal experience of post-exertional muscle pain (E, F)--a phenomenon which is well-known to be due to muscle microtrauma (G-J). It would appear that in fibromyalgia patients, muscle microtrauma occurs at very low levels of exertion and is much slower to heal than in normal individuals. The resulting functional disability often causes a significant curtailment in the quality of life as regards both vocational and avocational activities.
Patients with the fibromyalgia syndrome have abnormal sleep pattern characterized by EEG changes termed the alpha delta sleep anomaly (K, L). The sleep anomaly is characterized by an abnormal EEG in stages 3 and 4 of non-REM sleep with a super-imposition of a waking rhythm (10 cps--alpha rhythm) over the typical stage 4 rhythm cycles cps--delta rhythm). Furthermore, the induction of this sleep anomaly in healthy adults results in symptoms and clinical findings similar to those noted in fibromyalgia patients (M). The clinical correlative of EEG abnormality is non-restorative sleep--typically these patients awaken feeling tired and exhausted even if they have slept a normal number of hours.
Most patients with fibromyalgia have a reduced "quality of life", particularly as regards physical exertion, sleep, employment, sex life, vocational pursuits and maintaining friendships (AA). Heretofore, there has been no generally accepted efficacious treatment of fibromyalgia (F,AB); the best that could be achieved was to help patients learn to live with their problem through costly multidisciplinary treatment programs (1).
For many years the link between abnormal sleep and muscle pain remained an enigma. My discovery of low levels of somatomedin-C in a majority of patients with the fibromyalgia syndrome provides a link between sleep and muscle pain (N).
Growth hormone, through its action on the liver and the stimulation of somatomedin-C production, is an important hormone in maintaining muscle homeostasis (O, P). Recent studies attest to the beneficial effects of supplemental growth hormone in growth hormone deficient adults (Q-V).
I have discovered that fibromyalgia patients have a highly significant reduction in their somatomedin-C levels (p=0.000001). Accordingly, supplemental growth hormone injections would provide a clinical benefit in the treatment of fibromyalgia.